Debunking ICD-10 legends

By Carl Natale
09:09 AM

Many healthcare organizations are focusing on being ready for the ICD-10 changeover on Oct. 1. Just as important is what will come after that.

Productivity losses
This is legend. The fear is that ICD-10 code set is so large and complex that medical coders aren't going to be able to keep up with their current coding output.

ICD-10 opponents like to point to Canada's 40 percent drop in coding productivity after their ICD-10-CA implementation. But they also switched from a paper-based system to PC-based system at the same time. Canadian coders had a lot to learn and get used to.

Whether American coders will face comparable challenges is something we won't know until after Oct. 1. But those challenges could be mitigated by strong ICD-10 training and clinical documentation improvement (CDI) programs. These investments could help preserve medical claim productivity.

After Oct. 1, medical practices could look for other ways to streamline medical coding workflow. Remove inefficiencies. Add automation.

This is another legend. The American Medical Association (AMA) is predicting denial and rejection rates as high as 20 percent. Which is the basis of their call for an ICD-10 grace period.

Before medical practices panic over that possibility, they need to know their denial statistics now so they can compare what happens to claims after Oct. 1. They need to track:

  • Days in accounts receivable by healthcare payer
  • Denial rates
  • Amount of reimbursements denied
  • If reimbursements match the contracted rates
  • If tracking waits for Oct. 1, medical practices won't know if the numbers reveal problems or business as usual. Weekly tracking could help keep small problems from becoming big ones at the end of the month.

And if tracking spots problems, there needs to be a process to contact healthcare payers for find out what is the status of claims.

ICD-10 denial management starts now. Medical practices need to understand what triggers denials now and what could cause problems with ICD-10 claims. This will help prevent crippling reimbursement delays.

If physicians aren't documenting at a level that supports ICD-10 specificity, the number of queries from medical coding staff will increase. And that's going to affect productivity for coders and clinicians. To keep the documentation process moving smoothly, medical coders can improve their queries to make them as efficient and useful as possible:

  • Write in clear, concise and precise language
  • Use evidence specific to the case
  • Avoid asking leading questions
  • Include query in the clinical documentation
  • Start using ICD-10 language
  • Avoid writing queries

Unfortunately these issues will require resources after Oct. 1. That date is not the finish line. Medical practices need to keep running long after the ICD-10 deadline.

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